A case of ascending colon variceal bleeding treated with venous coil embolization

Abstract

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia. An esophagogastroduodenoscopy did not demonstrate any bleeding source, and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus. The source of the bleeding could not be found with a mesenteric artery angiography. We performed an enhanced abdominal computed tomography, which revealed a distal ascending colonic varix, and assumed that the varix was the source of the bleeding. We performed a venous coil embolization and histoacryl injection to obliterate the colon varix. The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed. We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.

Keywords: Colon ascending; Liver cirrhosis; Therapeutic embolization; Varicose veins.

Figure 1

Initial colonoscopy. A: The terminal ileum showing yellowish-colored stool with no evidence of upper gastrointestinal bleeding; B: The ascending colon showing fresh blood without an observable source.

Figure 2

Mesenteric artery angiography. A: The inferior mesenteric artery angiography showing no source of bleeding; B: The superior mesenteric artery angiography showing no source of bleeding.

Figure 3

The second colonoscopy. A: Massive hemorrhage within the proximal ascending colon without a definite bleeding focus; B: Fresh blood within the distal ascending colon without a definite bleeding focus.

Figure 4

Abdominal computed tomography. A: Portal phase axial view with white arrow showing the varix surrounding and protruding inside the ascending colon formed by portacaval shunt; B: Coronal view with white arrow showing the colon varix.

Figure 5

Venous coil embolization. A: Venography showing the varix within the ascending colon (black arrow); B: Coil embolization (black arrow) and histoacryl injection was performed to obliterate the varix.